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Hepatitis C and Fibromyalgia: The Possible Link

Nicole Cutler L.Ac. January 5, 2009

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Learn about the potential connection between Hepatitis C and fibromyalgia, and find out why it is possible that Hepatitis C infection may act as a trigger for fibromyalgia syndrome. If you suspect having both conditions, awareness of this link can lead you to seek the expert evaluation and care that may help reduce your symptoms of pain and fatigue.

Due to overwhelming empirical evidence, some medical circles believe that the symptoms and presenting patterns shared between Hepatitis C and fibromyalgia are beyond coincidental. While Hepatitis C is known to be transmitted through infected blood, authorities are still debating how fibromyalgia is acquired. Due to similarities in manifestation and physiology, there is a possibility that Hepatitis C infection may be one of fibromyalgia syndrome’s triggers. If you suspect having both conditions, awareness of this link can lead you to seek the specialized evaluation and care that may improve your most frustrating symptoms.

Prevalence

Estimates of disease prevalence in the United States approximate the number of people living with fibromyalgia to be around 6 million people, while the number of people known to be living with Hepatitis C hovers just above 4 million. While accurate statistics of the number of people affected by both diagnoses are not currently available, a surprising number of people dually diagnosed with Hepatitis C and fibromyalgia are emerging. However, one study did find the prevalence of fibromyalgia in people with Hepatitis C (15 to 19 percent) to be much higher than the occurrence of fibromyalgia in the general American population (2 percent).

Fibromyalgia

Fibromyalgia is a syndrome causing widespread muscle pain, extreme fatigue and multiple tender points in specific parts of the body. With pain characterized as aching, burning, stabbing and throbbing, its severity can vary widely. While fibromyalgia is a chronic condition, it is not a progressive disease. However, this condition can greatly reduce the quality of life of those affected.

Experts do not agree on what causes fibromyalgia. When trying to determine the etiology of this complex syndrome, it is challenging to discern between cause and effect. The endless cycle of pain, inactivity, insomnia, fatigue and depression typical of fibromyalgia complicates the isolation needed to trace this syndrome’s origins. Although researchers have identified several possible reasons for fibromyalgia, it remains unclear if they are a cause, or part of the problem. Some of the leading contenders for what triggers fibromyalgia include:

  • Hormone Imbalance
  • Infectious Disease
  • Immune System Malfunction
  • Sleep Disorder
  • Traumatic Event
  • Muscle Abnormality

The Hepatitis C Connection

Although not yet confirmed, many experts believe that Hepatitis C may act as a trigger to the onset of fibromyalgia. The documented links between the two conditions include:

  • Symptom Specificity – Fibromyalgia and chronic Hepatitis C infection share many clinical features including musculoskeletal pain and fatigue. While the two conditions do not always accompany each other, some symptoms may be unique when a person has both fibromyalgia and Hepatitis C. One study found that people dually diagnosed with fibromyalgia and Hepatitis C exhibit symptoms such as inflammation around a joint, bursa and/or tendon, and vasculitis (blood or lymph vessel inflammation) that are not seen in Hepatitis C negative people with fibromyalgia.
  • Immune Proteins – Cytokines are proteins that regulate immune response. Interleukins are a specific type of cytokine that cause a person to feel pain. Several interleukins have been found to be dramatically elevated in fibromyalgia patients. Harvard researchers found those same interleukins increased in production when exposed to the Hepatitis C virus.
  • Hepatitis C and Pain – Many people infected with Hepatitis C virus infection complain of myalgias, arthritis and widespread pain. When compared to other liver diseases, the frequency of musculoskeletal pain clearly favors Hepatitis C. The frequencies of musculoskeletal pain for the following isolated conditions are as follows: Alcoholic liver disease = 48 percent, Hepatitis B = 59 percent and Hepatitis C = 91 percent. As fibromyalgia’s most prominent symptom, it is not surprising that musculoskeletal pain may represent the link to Hepatitis C.

Infectious Cause

Certain infections, notably viruses, often occur in the histories of people with fibromyalgia. As these infectious organisms invade the body, scientists think they may cause damage at a cellular level. While fibromyalgia is considered to be non-contagious, it is possible that it may be a manifestation of a viral disease such as Hepatitis C, which is contagious. While many infectious microorganisms have been tied to fibromyalgia, the link with Hepatitis C is becoming increasingly suspect. At this point, there is sufficient evidence linking infectious diseases and fibromyalgia together, but it is unknown if any of these microorganisms are fibromyalgia’s origin, a simultaneous condition or a result.

Why it Is Important

A high prevalence of fibromyalgia has been found in patients infected with Hepatitis C, especially women. According to Israeli researchers, recognizing fibromyalgia in people with Hepatitis C will prevent misinterpretation of fibromyalgia symptoms as part of the liver disease and enable physicians to correctly focus on alleviating these symptoms.

A doctor well versed in fibromyalgia should be consulted if this syndrome is suspected. Because its diagnosis is not simple and symptoms often overlap with other conditions, a proper evaluation will test for fibromyalgia while ruling out other diseases. Doctors who are familiar with fibromyalgia typically make a diagnosis based on criteria established by the American College of Rheumatology (ACR). Those criteria are:

  1. Widespread pain (right and left side body pain, above and below the waist) that lasts for more than 3 months.
  2. Eleven or more tender points present at 18 specific sites on the body.

Whenever there is a profound crossover in a disease’s symptoms, we can learn from their parallels. Although many questions shroud the connection between fibromyalgia and Hepatitis C, their relationship exists in many people with either condition. With their comparable symptoms, similar immune biochemistry and irrefutable statistics of simultaneous presentation, exposure to the Hepatitis C virus may be one of fibromyalgia’s triggers.

Understanding this connection may prompt a person with fibromyalgia to get tested for Hepatitis C or it may help a person with Hepatitis C seek evaluation for fibromyalgia. If you think you might be burdened with both conditions, discuss your thoughts with your primary healthcare provider. By taking this proactive stance, you may open yourself up to new ways of reducing Hepatitis C’s challenging symptoms of pain and fatigue.

References:

www.archinte.ama-assn.org, Fibromyalgia in hepatitis C virus infection. Another infectious disease relationship, Buskila D., et al, Archives of Internal Medicine, November 1997.

www.cdc.gov, Viral Hepatitis C Fact Sheet, US Department of Health and Human Services, 2007.

www.hcvadvocate.org, Extrahepatic Manifestations: Hepatitis C and Fibromyalgia, Alan Franciscus, HCV Advocate, July 2006, Hepatitis C Support Project, 2007.

www.ihop-net.org, Fibromyalgia, hepatitis C infection and the Cytokine connection, Thompson ME, Barkhuizen A, Current Pain and Headache Reports, 2003.

www.medscape.com, Fibromyalgia Pain: Do We Know the Source?, Roland Staud, Current Opinion In Rheumatology, April 2004.

www.rheumatology-oxfordjournals.org, Fibromyalgia-associated hepatitis C virus infection, Rivera J, et al., The British Journal of Rheumatology, 1997.

www.vir.sgmjournals.org, Structural proteins of Hepatitis C virus induce interleukin 8 production and apoptosis in human endothelial cells, Anuradha Balasubramanian,, et al., Journal of General Virology, 2005.

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HepatitisCentral.com provides information regarding hepatitis and liver disease. Comments are available to the community in order to discuss these topics and obtain answers to questions through community members. The Editors at HepatitisCentral.com will not be responding to questions or comments posed in article comments.

  • Barbarakilcrease

    I have chronic pain fibromyalgia and neuropathy..my cousin thought that I should be tested for hepatitis C what do you think about that

    • Timexcat

      Yes, I have both and cirrhosis. Hope your negative

  • Hazy999

    this is very interesting. I was finally diagnosed with Fibromyalgia after about 8 years of symptoms. I was recently found to have Hep C too, and very likely have had it for about 10 years. 

  • brendaelk

    I had to come back to try Lyrica again, I hate how hungry I get on it but I can not get much relief from antidepressants because of side effects, and the pain is wearing me down, Tired of searching for meds that can help, it is a terrible disease and oh so hard to treat for everyone. We have to watch what we take due to liver problems and that makes it just that much harder to get relief from a pill!

  • ShaSha1992

    Hi my name is Lindsay and I’m only 19 years old.
    I’ve had Hep C since birth.
    Although rare I got it through the urterus
    I recently found out that I had gotten this diease because of my mother’s drug use (shooting up).
    Around the age of 5 I was diagnosed with fibromyalgia, yes I’ve already had the diease for 14 years.
    The fatigue is extreme but weither that is due to my fibromyalgia or Hep C I’m unsure.
    The widespread pain is extreme so I know what you guys are going through. I also tried the fibromyalgia medicines such as lyrica but had an allergic reaction to the medicines. However I did find they helped quite a bit.
    I find that anti-stress pills such as (lorzapan) help termendously with my pain and spasms (actually they work better than anything).
    I have recently moved out of my house after finding out the cause of my issues and the depth of my mothers drug problems,
    I have just started Hep C treatment tonight with the pills and weekly shots however I’m really scared on how this is going to affect my fibromyalgia.
    I was actually just trying to research that exact thing, I had no idea there were links between the two dieases.
    My 13 year old brother suffers from both as well. (again extremly rare… I guess we were just lucky “lol”)
    I find this scary and intresting at the same. I would suggest getting tested for both just in case to anyone who has one or the other. 
    Best Wishes!

    Xoxoxo
    Lindsay <3

  • brendaelk

    How much are vitamin D do we need if we have both fibro and hep c? Do you think we are low in Vitamin D and should take more everyday?

  • brendaelk

    I just wandered if you got tested for hep and what the results were?

  • Terri Touri

    OMG, I just have learned so much reading these 7 comments. I was diagnosed approximately in 2008 with Fibro; however, because back then it was a disease that was “in your head” and my doctor really wanted to help me, plus, the fact that I also tested positive for RA, he used RA as my disability reason. Actually, I was in soooo much pain I found it difficult to do anything. I would literally drag into his office crying in pain pain pain – all over. I was distraught from the pain. I am right back where I was back then! Since then, I have also been diagnosed with neurapathy. I